- See:
-
Phalangeal Injuries
-
Rheumatoid Boutonniere
-
Thumb Boutonnere Injuries
- Discussion:
- an aquired lesion of the
extensor mechanism, in which the PIP joint develops a flexion deformity and the the DIP joint develops an extension deformity;
- w/ time, these deformities become fixed, as the surrounding ligaments and volar plate become contracted;
-
pathology and mechanism of injury:
-
differential diagnosis:
- collateral ligament injury (w/ acute injuries)
-
volar PIP dislocation
- pseudo-boutonniere:
-
flexion contracture of PIP joint w/o hyperextension of DIP joint;
- may result from forced hyperextension of flexed PIP joint (such as rope being jerked from hand) resulting in injury and scarring of PIP volar plate and ligaments;
- may result from chronic extensor tendon subluxation over the MP joints;
- Clinical Presentation and Exam:
- Radiographs:
- look for
dorsal chip frx from base of middle phalanx which represents an
avulsion of bone by the central slip of extensor tendon;
- Non Operative Treatment and Splinting:
- Surgical Indications:
- failure of non operative treatment;
- at least 3 months of splinting should be tried prior to surgery;
- full passive ROM of the PIP and DIP joint needs to be established, prior to surgical correction;
- boutonniere injury with avulsion fracture w/ free frag overlying PIP
- long standing Boutonniere injury in a young person;
-
volar PIP dislocation central slip should be repaired;
- boutonniere w/ Fracture:
- a large displaced avulsion fracture requires open reduction and internal fixation;
- as a part of fracture fixation, it is also important to repair triangluar ligament inorder to correct volar subluxation of
lateral bands;
- excessive reefing of these bands will limit subsequent flexion of joint;
-
open boutonniere injury: (laceration)
- central slip is repaired w/ non absorbable suture along w/ splitting of PIP for 4-6 weeks (DIP is left free);
- Soft Tissue Reconstructive Procedures:
- Chronic Boutonniere: (more than 2 months after injury);
Chronic boutonniere deformity--an anatomic reconstruction.
The management of chronic posttraumatic boutonniere deformity.
Surgical repair of the boutonniere deformity of the fingers.
Correction of the severe nonrheumatoid chronic boutonniere deformity with a modified Matev procedure.
Biomechanical evaluation of chronic boutonniere reconstructions.
Tendon reconstruction for postburn boutonniere deformity.
Year Book: Operative Treatment of the Post-Traumatic Boutonniere Deformity: Deformity: A Modification of the Direct Anatomical Repair Technique.
Caroli-A.
Zanasi-S.
Squarzina-PB.
Guerra-M.
Pancaldi-G.
1992 Year Book of Hand Surgery. Article 6-10.
Original Article: J Hand Surg. 1990. 15-B. pp 410-415.
The Problem of Boutonniere Deformity.
W.A. Souter MD.
COOR No 104, Oct 1974. p 116.
The Proximal Interphalangeal Joint.
Anatomy and Causes of Stiffness in the Fingers.
Kuczynski, K.
JBJS 50-B: 656, 1968.
Transposition of the lateral slips of the aponeurosis in treatment of long standing "boutonniere deformity" of the fingers.
Matev, I.
British Journal of Plastic Surgery. 17: 281, 1964.
